Basic Information
| Provider Information | |||||||||
| NPI: | 1841325552 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | ELWOOD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5387 E RIVER RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857187247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205291908 | ||||||||
| FaxNumber: | 5206262416 | ||||||||
| Practice Location | |||||||||
| Address1: | 1224 EAST LOWELL STREET | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206265733 | ||||||||
| FaxNumber: | 5206262416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 13521 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.